TheCynicalPharmacist

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Tuesday, March 24, 2015

Strange days have found us. Strange days have tracked us down. They're going to destroy our casual joy…
I sometimes wonder what my topic or story will be for tomorrow's post. Sometimes I write days and weeks ahead. Other times, I make it up right before I set the post. Yesterday provided today's "Why do I care?" moment, while I was floating to another store.

CP: How may I hel…
Self-Obsessed Blonde: I don't like this pharmacy.
CP: Um...Thanks for telling me?
SOB: You don't have a drive-thru.
CP: I know. I love that. That's why…
SOB: I had to walk all the way to the back.
CP: We're actually on the side, but no bother. So why are you here, exactly? Other than to prattle on about our inconveniences?
SOB: My friend asked me to bring this here because she likes this pharmacy. I can't see why.
CP: And I can't see how you two are friends.
SOB: What?
CP: Nothing.
SOB: I would never come here again.
CP: And that would make each and every one of my days brighter were I never to see you again. And you didn't have to walk all the way to us. You could have commandeered a motorized scooter. You could have skipped or jumped or traipsed or moonwalked, or danced, or sashayed to the pharmacy. Personally, I find myself reenacting the Ministry of Silly Walks routine as I make my way to the pharmacy. Sometimes it makes me late though. Sorry. You were complaining?
SOB: It's rather a pain to get back here and I have to wait.
CP: Do tell. Where is this Eden of pharmacies located? How can you have found the one pharmacy where there is no waiting, there are no lines, there is a drive-thru, and all your needs are met instantly? Never mind. I know the answer.
SOB: Well…
CP: Shh. Good Girl. You are THAT patient. The one everyone talks about before she arrives and after she leaves. They know you are coming so they hurriedly shuffle your prescriptions through to completion so as to ensure they don't have to deal with you any longer than possible. I bet they even draw straws or shout "not it!" or put their fingers to their noses to choose the loser who has to wait on you. Fortunately for me, you are not my patient and your friend is. Thanks for that.

Seriously though…Who has the moxie to enter a business and begin complaining? You already don't shop here. I don't need to know why you don't shop here. I would be happier never having had to hear this story about why you are here now. Go sit in the corner until I finish her prescription and think of other reasons to not like us. Write them down for me so I can forward them to corporate.

Monday, March 23, 2015

In a world overcrowded with pharmacies trying to one-up each other, one pharmacist is on a mission. His goal today? Selling Comprehensive Medication Reviews door-to-door vis-a-vis vacuum and encyclopedia salesmen of decades past. Today we join him on his quest for the Holy Grail (someone to say "yes").

1. Would you be interested in a CMR today? I could just come inside and demo my services for you. Just 25 minutes of your time and I can have you on your way to a happier, healthier you. Right here I see that you are taking a Statin. Did you know…? <door slams>

2. <Tips fedora>
Good day, ma'am. I would like to show you the power of the new CMR 3000. With this lovely service, you too can turn your frown upside down. Side effects from medication? Too many medications? Drug interactions from all those tablets you have to take 8 times a day? No more! With the CMR 3000 we can reduce those unwanted outcomes, cut your daily regimen, and minimize the burden on you so you can get on with your life and enjoy each day better. May I come in? <door slams>

3. Are you one of the millions of people out there who are going to die? My name is Syrio Forel and I say: "Not today". With a quick investment of just 20 minutes, I can demonstrate for you the powers of the CMR 3K and how it can save your life. <hears the phrase, "Chopper, sick balls!" and takes off running.>

Wednesday, March 18, 2015

Hope. Most days start with it. I'm not talking going all Snow White and singing with the birds hopeful, but more like Episode IV, A New Hope sort of optimism.

Did you ever think to yourself today was going to be your day? I go to work every day thinking to myself that it's a new day. It's like starting out the school year with straight A's. Even though you haven't had a class yet, it's up to you to keep the grades. Then something happens and it all goes away. Like work. Stupid happens and your day goes from newborn Bambi optimism to "BAM" dead mom Bambi misery.
It's times like these that we have to remember that our fellow humans are out there, populating the world, waking up, dressing themselves, operating vehicles, working jobs, navigating the daily grind, feeding themselves…and asking questions like these:

1. Why didn't you call to tell me my bottle was empty?
2. Why didn't you tell me my bottle says "no refills"?
3. Why didn't you tell me I was out of insulin?
4. Why didn't you tell me I had no syringes left to inject my insulin I use every day?
5. It says "do not drink alcohol with this medication". Can I have just a couple beers tonight?
6. It says "Take with food". Is toast okay?
7. My copay is $10. Why are you charging me $30 for 3 prescriptions?
8. I heard red wine is good for the heart and I don't want to see a doctor. What kind do you recommend?
9. I broke a clot in my foot. Should I wash it?
10. What's a prescription? Is that that paper I get from the doctor?
11. There was a man there in the pharmacy. Or maybe it was a girl.
12. I filled an application down there. Does it interact with anything?
13. Can I smoke marijuana if I use the Nicotine Patch?
14. The wait time is 20 minutes? Can I go home and come back tomorrow?
15. The directions say 2 times a day but my doctor said I could "eat 3 of these a day".
16. This is called a drive-THRU, right? Not a pull-up-and-wait?

Monday, March 16, 2015

Before you leave your prescriber's office, have him/her print the confirmation that the transmission to your pharmacy was successful. We here at the pharmacy use a variety of methods to receive your prescriptions from hundreds of prescribers every day, including, but not limited to: original hard copies, voicemails, electronic prescriptions, faxes, telekinesis, smoke signals, and hologram. Please make sure your prescriber indicates which method(s) of transmission they used.

Before leaving the office with confirmation in hand, review that your prescriber selected the correct pharmacy. If not, march right back into the room, ignoring the fact other patients may be in various stages of undress, and demand the prescriber fix it on the spot!

Prescribers are often in a hurry when entering prescriptions and are prone to making many, sometimes life-threatening, mistakes. In order to avoid this, as well as any delay in processing your prescription(s), please make your prescriber and his staff take the time to review your prescriptions for any typos or missing information. As we do at the pharmacy, make sure at that no fewer than 3 different people look at and verify the prescription for accuracy. If it arrives at the pharmacy with any errors at all, you will personally have to call the office back, from one of our phones, and demand the prescriber get on the phone and fix the problem forthwith.

Friday, March 6, 2015

If you bought items on eBay, or in a store, who much did you pay? Did you get a deal on them?
Let's say you choose to turn around and immediately put those items up for sale.
How much will you sell them for?
The amount you paid?
Less than what you paid?
More than what you paid? If so, how much more?

Let's pretend you are a pharmacy. You purchase some items from a wholesaler. Perhaps you got a deal on them, depending on the quantities you purchased. How much will you sell them for?
The amount you paid?
Less than what you paid?
More than what you paid If so, how much more?

Why is it that you would wish to make a profit on your personal resale business and as owner of your own pharmacy, but when a pharmacy attempts to make a profit, it's price gouging?

How many people out there have sold, or purchased, the must-have Christmas item for a woefully inflated price on eBay? Someone is able to buy multiples of this item. When demand soars, they put it up for sale to the highest bidder. While this is basic supply-and-demand, most businesses do not adjust their prices daily to respond to market conditions (see gas prices).

When we pay more for what we buy, we have to charge more. With law changes going into effect that impact what manufacturers can charge for their medications, they are raising some prices exponentially before they are not allowed to do so. This is one of the reasons medications will disappear for a few weeks then come back with 300% to 1000% price increases. While I am happy for you that you were able to get some things for under $10 last month, now it's going to cost you 2-3 times that.

Blaming the pharmacy for passing along these costs is like blaming the pizza delivery guy for the spike in pepperoni costs.

Thursday, March 5, 2015

It was one of those weekends where the conversation was deeper than the prescription pile. Winter had indeed come and along with it, the quiet solitude so rarely offered in the pharmacy department. Introspection and reflection led to a few epiphanies and aha moments.

This was not one of those. It did inspire a lively debate however.

I mentioned that past customers of mine, a single mom with 3 young boys, all of different surname, were telling me the story of their annual trip to Florida. I mentioned my excitement at the start of Spring Training and heard this account: "I take the boys to spring training every year for 2 weeks. We get them new balls and bats and hats every day so they can line up and get the players' signatures."

Huh. I must be doing something wrong.

Then the debate ensued.

My tech posited that we should dare to live the dream life that accompanies state aid.

I countered that we don't know how.

Uber-Tech: It can't be that hard.

CP: Sure it is. They have generations of knowledge.

UT: All within the last 4 decades.

CP: Just what was envisioned when the system was created.

UT: But how would it be possible for us to not succeed?

CP: We are too smart. We would try to be logical. Our way runs counter to how people think. We would have no problem paying for a $3.00 cough medicine for our children. These people, with years of experience, would yell and scream and walk away.

UT: Perhaps we should take notes.

CP: Like studying animals in their native environment?

UT: Exactly. What better place than here? Either a pharmacy or an ER.

CP: True. But we are also missing one key element.

UT: What's that?

CP: Pedigree.

UT: Yeah. They always can afford dog food.

CP: No. I mean being born into the right family.

UT: Someone to show us the ropes.

CP: Yes. Think about it like this. On one extreme, we have Tywin Lannister. He has the experience. He has the power. He has all the money and his children will inherit it and spend it and never run out of it. This is the product of being highborn. At the other end of the spectrum...
UT: ...you're saying that in order to be successful at the state aid game, you have to be born into the right family?
CP: Yes. Or married into it. Otherwise our family would go the way of House Reyne at Castamere.
UT: They will beat us with experience.
CP: Truly. Until then, we just have to commit ourselves to working every day to enable them to live out our dreams and live vicariously through them.
UT: I was really hoping for the new iPhone I could carry in my Coach purse while driving my Escalade.
CP: Dude. You're a guy. Why would you have a purse?
UT: Sorry. Someone has to comment on this thread with these 3 stereotypical items so I wanted to get them out of the way in the hopes I don't have to read through them later.
CP: Got it. See, there we go thinking inside the box again. I told you we don't know how play this game.

My question is: Where does it stop?
When I worked near a university, we had professors from all over the world living in town and filling prescriptions with us.
I didn't know if English was a primary language.
I didn't know what was their primary language.
I didn't know if their families were born here and could speak English.
What about people whose primary means of communication is American Sign Language?

I believe we should have a Themed Label Day.
Since no one is expected to learn English anymore, we could take this opportunity to teach other languages to everyone via our labels.

We could have Braille day for the blind.
ASL day for the hearing impaired.
National Talk Like A Pirate Day, just because...
We could have a special Yoda Speak label.
I am a fan of the poetic verse labels.
Haiku labels would be fun too.

One tablet a day you shall take. With food it must be.

Inhale two sprays into left and right nare
So you're not allergic to all the fresh air.

Thursday, February 26, 2015

Pharmacies should look into modeling their services and fees on the airline industry. If ever there were an ideal model of how to run a barebones operation it's the airlines.

The following offers/price schedules would be the norm:

1. Your first 2 prescriptions are free to process. Each additional prescription filled that day will incur an additional processing fee.

2. Electronic prescriptions and faxes will be processed for free, following Rule #1, while handwritten hard copies presented at the counter will incur an additional fee. (Exemptions for controls that must be handwritten in states that haven't caught up and passed the requisite laws just yet.)

3. If your prescription must be dispensed in multiple bottles (i.e. 180 Metformin 1000mg) there will be an additional charge for the extra label, vial and cap.
4. Any changes made to your prescription once it has been finalised (billing changes, quantity changes, coupon cards, etc) will result in additional fees.
5. Prescriptions not picked up and returned to stock will be assessed a restocking fee.
6. Prescriptions that have been restocked that you now wish to purchase will be charged the original copay, the restocking fee, the new copay, plus an additional "convenience" charge.
7. You must have your photo ID ready at pick up on all prescriptions and the name on the ID must match the name sent by the prescriber and the name we have on file.
8. Counseling is mandatory and FREE at time of purchase only. Any questions asked once the register transaction is completed will be assessed additional fees based on type of question asked and duration of consultation.
9. Your prescriptions have the right to be "bumped" for higher priority patients (sick children, emergencies, etc) if our queue is full. You will be compensated by having the additional prescription fee waived on a future fill date.
10. You must check in at the ticket counter (drop off) before going to the gate (pick up) to ensure your flight (prescription) is ready and arriving on time. If not, please have a seat in the lounge (waiting area) where you will be called to board.